[Impact of a protocol based on the new national recommendations on the use of oxytocin and its maternal-fetal consequences: a single-center before/after study.]

Abstract

OBJECTIVE\nEvaluate oxytocin use and impact on maternal and fetal morbidity before and after implementation of a protocol based on national recommendations.\n\n\nMATERIALS AND METHODS\nA single-center retrospective before-and-after study (Lille, France). A service protocol to harmonize the use of oxytocin was implemented in May 2017 following national recommendations. Data were collected from January to March 2016 for period 1, and from January to March 2019 for period 2. Nulliparous patients in spontaneous labor ≥ 37SA delivering a live newborn in cephalic presentation were included. The primary outcome was the use of oxytocin.\n\n\nRESULTS\n587 patients were included, 302 for period 1 and 285 for period 2. The rate of oxytocin use was 48% (n=144) in 2016 versus 28% (n=79) in 2019 (p<0.001). Total labor time was significantly longer after protocol implementation (425.7 min vs 510.4 min; p<0.001). The cesarean section rate was identical between the 2 periods (7.0% vs 6.0%; p=0.62). The rate of postpartum hemorrhage greater than 500 mL was higher in period 1 (17.7% vs. 10.9%; p=0.019), as was the occurrence of a pH < 7.05 (5.4% vs. 1.1%; p=0.004).\n\n\nCONCLUSION\nThe implementation of a protocol contributed to a decrease in the use of oxytocin and thus would allow a decrease in the rate of postpartum hemorrhage and neonatal acidosis, but with an increase in the duration of labor.